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Columbia  University 

College  of  Physicians  and  Surgeons 

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AN  IMPROVED  METHOD  OF  GENERAL  ANES- 
THESIA IN  HEAD-SURGERY  BY  MEANS 

OF  GLASS  NASAL  TUBES  * 


JOSEPH  E.  LUMBARD,  M.D. 

Anesthetist  to  the  Harlem  Hospital,  the  General  Memorial  Hospital 

and    the    Lying-in    Hospital ;    Fellow    New    York 

Academy  of  Medicine,  etc. 

NEW  YORK 


Anesthesia  for  head-surgery  certainly  presents  diffi- 
culties for  the  anesthetist.  In  order  to  insure  greater 
safety  to  the  patient  and  less  interference  of  the  anes- 
thetist with  the  surgeon  during  an  operation  on  the 
head,  many  inhalers  have  been  produced.  Nasal  tubes 
for  such  purposes  of  anesthesia  were  introduced  in  190b 
by  Dr.  Edwin  Pynchon  of  Chicago  and  Dr.  Stuart  B. 
Blakely  of  New  York  independently.  Since  one  of 
these  instruments  allows  the  entrance  of  too  much  air 
and  the  other  does  not  provide  sufficient  air,  I  have 
devised  an  instrument  which  experience  has  proved  to 
be  more  practical  than  any  other  on  the  market. 

My  apparatus  consists  of  two  glass  tubes  (Fig.  1,  A 
and  B)  so  bent  that  each  will  properly  fit  a  nostril. 
These  tips  are  connected  with  the  mechanism  which  sup- 
plies the  anesthetic  vapor  by  means  of  two  soft  rubber 
tubes  (Fig.  1,  C),  joined  together  at  the  supply  end  by  ;i 
glass  Y,  which  also  connects  them  with  the  supply  tube 
(C)  itself.  They  are  furnished  in  three  different 
sizes  in  order  to  make  the  apparatus  adapted  to  nostrils 
of  different  shapes. 

Furthermore,  the  apparatus  which  I  use  for  continu- 
ing the  anesthesia  is  different  from  that  employed  hy 
either  Dr.  Pynchon  or  Dr.  Blakely.  I  induce  anes- 
thesia in  the  usual  way  and  then  introduce  the  glass 

*  Demonstrated  before  the  Harlem  Medical  Association,  May  14 
1910,  and  the  Valentine  Mott  Medical  Society,  May  24,  1910. 


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nasal  tips  into  the  nose.  For  convenience  these  may  be 
held  in  position  by  means  of  a  small  piece  of  adhesive 
plaster  placed  across  them  transversely  on  the  forehead 
(Fig.  2).  The  anesthesia  is  then  continued  by  supply- 
ing the  vapor  in  one  of  four  ways:  first,  by  the  Crile 
method,  that  is,  by  the  use  of  a  funnel  and  tube  (Fig. 
1,  C),  on  the  stretched  gauze  of  which  ether  is  dropped; 
second,  by  the  one-bottle  Junker  apparatus,  as  used  so 


Fig.  1. — Glass  nasal  tubes  for  general  anesthesia  in  head-surgery 
(A  and   B)  ;   connected  with   supply   tube    (C). 


commonly  in  England  for  head-surgery;  third,  by  the 
two-bottle  modification  of  the  Junker  apparatus,  as  used 
by  Dr.  T.  W.  Brophy  of  Chicago  for  work  on  cleft  pal- 
ates; fourth,  by  the  Gwathmey  three-bottle  modification 
of  the  Junker  apparatus.  By  each  of  the  Junker  meth- 
ods anesthesia  vapor  is  pumped  into  the  nostrils  by 
means  of  suitable  bulbs. 


I  much  prefer  the  Gwathmey  apparatus,  as  it  allows 
the  use  of  both  ether  and  chloroform,  either  singly  or 
combined  in  any  proportion,  with  the  greatest  safety 
and  ease. 

The  following  are  some  of  the  advantages  of  the  glass 
nasal  tips  over  the  long  rubber  tubes  which  have  been 
in  common  use : 


Fig. 


-Glass  nasal  tubes  for  anesthesia   in   use. 


1.  They  are  more  safely  and  easily  introduced  into 
the  nose. 

2.  They  allow  the  anesthetic  vapor  on  its  way  to  the 
lungs  to  become  warmed  by  the  nose. 

3.  Successful   use.  of   the   instrument   is   in   no   way 
interfered  with  by  a  deformed  nasal  septum  or  exostosis. 


4.  They  do  not  cause  nasal  hemorrhage. 

5.  They  cannot  become  obstructed  with  blood  and 
mucus. 

6.  They  remain  in  position  much  better  than  rubber 
tubes. 

7.  They  are  easier  to  clean  and  sterilize. 

A  method  very  similar  to  mine  has  been  successfully 
employed  at  Boosevelt  Hospital  in  New  York  City, 
where  it  is  now  entirely  used  for  head-surgery  in  place 
of  rectal  anesthesia. 

The  glass  nasal  tips,  as  above  illustrated,  are  certainly 
a  most  excellent  means  of  producing  a  safe  and  contin- 
uous anesthesia  in  head-surgery,  not  interfering  with  the 
surgeon. 

1925  Seventh  Avenue. 


Reprinted   from   the  Journal  of   the  American  Medical  Association 
Oct.  8.  1910,  Vol.  LV,pp.  1258  and  1259 


Copyright,  1910 
American  Medical  Association,  535  Dearborn  Ave.,  Chicago 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/improvedmethodofOOIumb 


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An  improved  method  of  general  anesthesia 


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